Bill S.2096
188th (2013 - 2014)

An Act relative to patient financial protection

Bill Title: An Act relative to patient financial protection

The committee on Health Care Financing, to whom was referred the Senate Bill relative to patient financial protection,- reports, recommending that the same ought to pass with an amendment substituting a new draft with the same title (Senate, No. 2096).

SECTION 1. Chapter 32A of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by inserting after section 17K the following section:—

Section 17L. Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth that provides coverage for prescription drugs shall establish a separate out-of-pocket limit for prescription drugs, including specialty drugs, limited to no more for self-only and family coverage per year than the minimum dollar amounts in effect under section 223(c)(2)(A)(i) of the Internal Revenue Code of 1986 for self-only and family coverage, respectively. For the purposes of this section, the use of the term "out-of-pocket limit" shall be consistent with the definitions of those terms as prescribed by the Secretary of the United States Department of Health and Human Services pursuant to Section 2715 of the federal Affordable Care Act.

SECTION 2. Chapter 175 of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by inserting after section 47DD the following section:—

Section 47EE. Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth that provides coverage for prescription drugs shall establish a separate out-of-pocket limit for prescription drugs, including specialty drugs, limited to no more for self-only and family coverage per year than the minimum dollar amounts in effect under section 223(c)(2)(A)(i) of the Internal Revenue Code of 1986 for self-only and family coverage, respectively. For the purposes of this section, the use of the term "out-of-pocket limit" shall be consistent with the definitions of those terms as prescribed by the Secretary of the United States Department of Health and Human Services pursuant to Section 2715 of the federal Affordable Care Act.

SECTION 3. Chapter 176A of the General Laws, as so appearing, is hereby amended by inserting after section 8FF the following section:—

Section 8GG. (a) Any contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth that provides coverage for prescription drugs shall establish a separate out-of-pocket limit for prescription drugs, including specialty drugs, limited to no more for self-only and family coverage per year than the minimum dollar amounts in effect under section 223(c)(2)(A)(i) of the Internal Revenue Code of 1986 for self-only and family coverage, respectively. For the purposes of this section, the use of the term "out-of-pocket limit" shall be consistent with the definitions of those terms as prescribed by the Secretary of the United States Department of Health and Human Services pursuant to Section 2715 of the federal Affordable Care Act.

SECTION 4. Chapter 176B of the General Laws, as so appearing, is hereby amended by inserting after section 4FF the following section:—

Section 4GG. (a) Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth that provides coverage for prescription drugs shall establish a separate out-of-pocket limit for prescription drugs, including specialty drugs, limited to no more for self-only and family coverage per year than the minimum dollar amounts in effect under section 223(c)(2)(A)(i) of the Internal Revenue Code of 1986 for self-only and family coverage, respectively. For the purposes of this section, the use of the term "out-of-pocket limit" shall be consistent with the definitions of those terms as prescribed by the Secretary of the United States Department of Health and Human Services pursuant to Section 2715 of the federal Affordable Care Act.

SECTION 5. Chapter 176G of the General Laws is hereby amended by inserted after Section 4X the following section:—

Section 4Y. (a) Any individual or group health maintenance that provides coverage for prescription drugs shall establish a separate out-of-pocket limit for prescription drugs, including specialty drugs, limited to no more for self-only and family coverage per year than the minimum dollar amounts in effect under section 223(c)(2)(A)(i) of the Internal Revenue Code of 1986 for self-only and family coverage, respectively. For the purposes of this section, the use of the term "out-of-pocket limit" shall be consistent with the definitions of those terms as prescribed by the Secretary of the United States Department of Health and Human Services pursuant to Section 2715 of the federal Affordable Care Act.

SECTION 6. Sections 1 to 5, inclusive, shall apply to all policies, contracts and certificates of health insurance subject to section 17L of chapter 32A, section 47EE of chapter 175, section 8GG of chapter 176A, section 4GG of chapter 176B and section 4Y of chapter 176G of the General Laws which are delivered, issued or renewed on or after January 1, 2015.

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